Colorado Danger Signs On Medical Emergency

By WILLIAM E. SCHMIDT, Special to the New York Times

Published: April 12, 1988

BYERS, Colo. April 7—
The town's only doctor left long ago and the closest clinic closed its doors in February. So what now passes for emergency medical care on this part of the Colorado high plains is a 10-year-old ambulance with a volunteer crew and a bumpy 45-minute ride to Denver.

''And that's only if we can keep the ambulance running,'' said Jo Eikelberry, who supervises the 13-member rescue squad in this tiny rural crossroads of 200 people, an exit off Interstate 70 50 miles east of Denver.

Across much of rural America, access to emergency health care has been defined by the range of the local ambulance. Now, just as the depressed rural economy is forcing many country doctors and local hospitals to close their doors, towns like Byers also are finding it increasingly difficult to come up with the money and the trained personnel to keep the state's aging network of ambulances at work.

The problems have been acute in Colorado and other states in the West. Vast distances separate small towns in this region, and the financing of local ambulance services has often been left to local governments or groups of volunteers whose only sources of revenue are having a fish fry or a charity auction. Fear of 'Full-Blown Crisis'

As a result, Lieut. Gov. Mike Callihan of Colorado said rural emergency health care in the state is facing ''a full-blown crisis,'' a situation that affects not only the people who live in these remote places, but also the tourists and others who travel the state's rural roads and remote stretches of interstate.

''Because of the decline in agriculture and energy, these rural areas just don't have the money or the people to keep these services going the way they should,'' said Mr. Callihan, not only pointing to rising operating costs, but also to steep increases in liability insurance. ''There are places in this state where you better pray you don't have an accident,'' he added.

Largely as a result of Congress's decision in 1981 to curtail Federal assistance, which in the 1960's and early 1970's provided millions of dollars that enabled many small towns to buy ambulances and train personnel, the state's budget for emergency medical services has declined 70 percent.

Meanwhile, Colorado's Legislature has refused to help local communities make up the difference, contending that because of the state's depressed economy, the money is not there to take on such new obligations.

''What are we supposed to do then?'' asked William R. Metcalf, the director of state Emergency Medical Services. ''Post signs on the interstate that say: 'Drive carefully for the next 20 miles, because if you do have an accident no one will come'?'' When Emergency Occurs

According to The Rocky Mountain News in Denver, that is almost what happened to one man last summer, when his Jeep went out of control on a country road in western Colorado and rolled over on him, fracturing his pelvis and causing internal injuries.

The nearest ambulance, in the firehouse at New Castle, less than a mile away, was out of service, because the local ambulance company could not afford repairs on the 12-year-old vehicle.

The man did survive, thanks to a group of local residents who gave him first aid in the back of a pick-up truck until a helicopter arrived, more than an hour later, from Grand Junction.

A fleet of seven helicopter ambulances, operated by hospital and private companies, do help, but Mr. Metcalf said they lack the range to cover the whole state, and their operations are limited by bad weather and rough terrain.

Mr. Metcalf said that last year a survey by the State Auditor concluded that an accident victim was three times more likely to be killed in a rural area.

The nation's network of emergency medical services was built up largely as a result of the Federal Emergency Medical Services Systems Act of 1973, which provided millions of dollars in grants that enabled local communities to buy ambulances and communications equipment. Turning Point on Funds

But Federal aid all but stopped after passage of the Omnibus Budget Reconciliation Act in 1981, as the Reagan Administration pressed Congress to shift the burden for financing such services back to the states and local governments.

For the most part, urban areas have been able to make the transition, while rural areas, where population is widely dispersed and per capita operating costs are higher, have had more difficulty keeping pace.

''What you are seeing in Colorado is the logical end result of the philosophy of trickle-down economics,'' said Mr. Callihan, a Democrat. ''Ambulance service in rural areas has trickled down to almost nothing.''

The General Accounting Office in Washington took notice of the differences in quality between urban and rural emergency medical service in a 1986 report. As a result, Senator Alan Cranston, the California Democrat, has introduced legislation to provide more Federal money to rural areas to buy communication equipment and establish regional trauma networks to serve sparsely settled areas.

Barbara Masters, an aide to Mr. Cranston, said that given the overall decline in rural health care, ''the role of the paramedic cannot be overemphasized.''

''It is essential, particularly in the West, where you have these huge distances,'' she said. Tensions Within State

Mr. Callihan said the refusal of the Legislature in Colorado to finance rural emergency services underscores the tension between urban and rural lawmakers. ''Urban interests dominate the Legislature,'' he said. ''And in the politics of scarcity, which this state must now practice, the rural areas are losing.''

Mr. Callihan said the failure of the state to finance these emergency medical services is also shortsighted, because it contradicts efforts by the state to increase tourism and new investment in Colorado.

''We've got to remember that tourists drive through these rural areas on their way to and from ski areas,'' he said.

In Byers the local ambulance averages about 2.5 calls a week and serves an area of nearly 800 square miles, in which fewer than 1,400 people live. It is also responsible for stretch of about 14 miles on Interstate 70, the state's main east-west artery.

Last year, as local income declined along with dwindling oil and agriculture receipts, donations to help run the local ambulance service slipped to $5,000 from $8,500. Meanwhile, liability insurance premiums doubled, to $3,600 a year, and mechanical problems with the aging ambulance forced up operating costs.

In addition, said Mrs. Eikelberry, the number of volunteers has declined from 20 to 13. At times in the day, there is only one person on call to respond to emergencies.

''People here don't want us to go away,'' said Darl Landis, a volunteer. ''But they can't afford a new $40,000 ambulance either.''

photo of Byers, Colo. ambulance on a rural road in the town (NYT/Brian Payne); map of Colorado highlighting Byers